【摘要】 目的 探讨IgA肾病肾血管病变的危险因素。 方法 回顾性分析2000年1月－2009年6月间经肾活检确诊的175例IgA肾病患者资料，其中有肾血管病变者93例，无肾血管病变者82例，进行对照研究。采用多因素非条件logistic回归模型分析影响IgA肾病肾血管病变的危险因素。 结果 高血压[OR=11.593，P=0.001，95%CI（2.800，47.991）]、24 h尿蛋白定量[OR=1.754，P=0.001，95%CI（1.270，2.424）]、血肌酐[OR=1.005，P=0.001，95%CI（1.002，1.008）]、肾小球硬化[OR=8.341，P=0.000，95%CI（2.716，25.610）]、肾间质纤维化[OR=4.880，P=0.014，95%CI（1.385，17.199）]对IgA肾病肾血管病变的影响有统计学意义。 结论 高血压、24 h尿蛋白定量、血肌酐、肾小球硬化和肾间质纤维化可能是影响IgA肾病肾血管病变的独立危险因素。积极控制以上危险因素对延缓IgA肾病病变的进展具有重要意义。【Abstract】 Objective To explore the risk factors for renal vascular lesions in patients with immunoglobulin A (IgA) nephropathy. Methods We retrospectively analyzed the clinical data of 175 IgA nephropathy patients diagnosed through renal biopsy from January 2000 to June 2009. Among them, there were 98 cases of renal vascular lesions and 82 cases without renal vascular lesion. Controlled study between the two groups of patients were carried out. A multivariate unconditional logistic regression model was employed to analyze the risk factors for renal vascular lesions in IgA nephropathy patients. Results The following factors had significant correlations with renal vascular lesions in IgA nephropathy patients: hypertension [OR=11.593,P=0.001,95%CI (2.800, 47.991)], 24-hour urine protein level [OR=1.754,P=0.001, 95%CI (1.270, 2.424)], serum creatinine [OR=1.005,P=0.001, 95%CI (1.002, 1.008)], glomerulosclerosis [OR=8.341,P=0.000,95%CI (2.716, 25.610)], and renal interstitial fibrosis [OR=4.880,P=0.014, 95%CI(1.385,17.199)]. Conclusion Hypertension, 24-hour urine protein, serum creatinine, glomerulosclerosis and renal interstitial fibrosis were risk factors for renal vascular lesions in IgA nephropathy patients. It will be very significant to actively control all the above risk factors to prevent occurrence of renal vascular lesions.
Objective To analyze and screen the risk factors of both immunohistochemistry and pathology for lung cancer lymphatic metastasis, and to build a mathematical model for preliminary evaluation. Methods By conducting retrospective studies, the information of lung cancer patients in the General Hospital of Air Force from 2009 to 2011 were collected. Both single and multiple unconditional logistic regression analyses were applied to screen total 27 possible factors for lymphatic metastasis. After the factors with statistical significance were selected, the relevant mathematical model was built and then evaluated by means of receiver operating characteristic (ROC) analysis. Results A total of 216 patients were included. The single analyses on 27 possible factors showed significant differences in the following 10 factors: pathological grade (P=0.00), age (P=0.00), tumor types (P=0.01), nm23 (P=0.00), GSTII (P=0.01), TTF1 (P=0.01), MRP (P=0.01), CK14 (P=0.02), CD56 (P=0.02), and EGFR (P=0.03). The multiple factors unconditional logistic regression analyses on those 10 risk factors screened 4 relevant factors as follows: pathological grade (OR=2.34), age (OR=1.02), nm23 (OR=1.66), and EGFR (OR=1.47). Then a mathematical diagnostic model was established based on those 4 identified risk factors, and the result of ROC analysis showed it could improve the diagnostic sensitivity and specificity compared with the single factor mathematical diagnostic model. Conclusion Pathological grade, age, nm23, and EGFR are related with lung cancer lymphatic metastasis, and all of them are the risk factors which have higher adjuvant diagnostic value for lung cancer lymphatic metastasis.
Objective To investigate the prognostic factors of esophageal squamous cell carcinoma（ESCC） by multivariate analysis of clinicopathologic features of ESCC between long-term and short-term survivals after esophagectomy. Methods The clinicopathologic features of randomly selected 126 cases with ESCC were analyzed with binary logistic regression, 48 cases of which was divided into long-term survival group（≥5 years） and 78 cases into short-term survival group（≤1 year） according to the follow-up. Results Under univariate analysis, the differences between two groups on tumor pathologic grading, metastasis to lymph node, depth of tumor invasion and length of tumor were significant （Plt;0.01）, however, that on age, gender, location of tumor and status of residues were not （Pgt;0. 05）. Multivariate analysis showed that tumor pathologic grading, metastasis to lymph node, depth of tumor invasion and length of tumor correlated with the prognosis of ESCC （Plt;0. 05）. Their risk coefficient were 2. 943, 2. 641, 2. 126 and 1. 728, respectively. Age, gender, location of tumor and status of residues did not correlated with the prognosis of ESCC （Pgt;0. 05）. Correlation analysis indicated that depth of tumor invasion was positively related to the length of tumor （r=0. 488, Plt;0. 001）, metastasis to lymph node was positively related with depth of tumor invasion and tumor pathologic grading （r=0. 216, P=0. 014; r=0. 238, P=0. 007）. Conclusions The main prognostic factors of ESCC are tumor pathologic grading, metastasis to lymph nodes, depth of tumor invasion and length of tumor,Tumor pathologic grading is high risk factor for prognosis of ESCC,while length of tumor is low risk factor. Age and gender of patients, location of tumor and status of esophageal residues are non-risk factors.
ObjectiveTo evaluate the predictors of generalized anxiety disorder (GAD) among teachers in 3 months after Lushan earthquake. MethodsA prospective cohort study was conducted to diagnostically evaluate the psychological sequelae and GAD during 14-20 days and 85-95 days after the earthquake. The possible predictive factors of psychological sequelae were assessed by a self-made questionnaire and the GAD was assessed by the GAD symptom criterion of M.I.N.I. in 3 months. The univariate and multivariate logistic regression analysis (ULRA, MLRA) were applied to analyze the predictors of GAD after the two-staged assessments. ResultsThere were a total of 319 teachers completed the two-staged assessments. The total response rate was 51.3%. Seventy teachers were diagnosed as GAD and the prevalence of GAD in 3 months was 21.9%. The predictive factors by ULRA included:male, older than 35 years old, having unlivable house, living in tents, sleeping difficulties, easy to feel sad, physical discomfort, loss of appetite, feeling short of social support, unable to calm down for working, feeling difficult for teaching, observing more inattention of students, and wanting to ask for a leave. The independent predictors by MLRA included:male, having unlivable house, feeling short of social support, and feeling difficult for teaching. ConclusionThe teachers have a higher likelihood of GAD after earthquake. It is essential to pay more attention to those male teachers, who feel short of social support and don't have a livable house thus to prevent the GAD at the early stage of post-earthquake.
Objective To approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.
Objective To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.?Methods?We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010. According to the presence of preoperative death, all the patients were divided into two groups, 9 patients in the preoperative sudden death （PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years；43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years. Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.?Results?Univariate analysis result showed 7 candidate variables：body mass index （BMI, Wald χ2=2.150, P=0.143）, time of onset （Wald χ2=2.711, P= 0.100）, total cholesterol （TC, Wald χ2=1.444, P=0.230）, low density lipoprotein cholesterol （L-C, Wald χ2=1.341, P=0.247）, aortic insufficiency （AI, Wald χ2=2.093, P=0.148）, aortic sinus involvement （Wald χ2=3.386, P=0.066）and false lumen thrombosis （Wald χ2=7.743, P=0.005）. Multivariate logistic regression analysis showed that BMI （Wald χ2=4.215, P=0.040, OR=1.558）and aortic sinus involvement （Wald χ2=4.592, P=0.032, OR=171.166 ）were preoperative risk factors for sudden death, and thrombosed false lumen （Wald χ2=5.097, P=0.024, OR=0.011）was preoperative protective factor for sudden death.?Conclusion?Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.
ObjectiveTo explore the risk factors for postoperative respiratory failure (RF) in patients with esophageal cancer, construct a predictive model based on the least absolute shrinkage and selection operator (LASSO)-logistic regression, and visualize the constructed model. MethodsA retrospective analysis was conducted on patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital from 2020 to 2023. Patients were divided into a RF group and a non-RF (NRF) group according to whether RF occurred after surgery. Clinical data of the two groups were collected, and LASSO-logistic regression was used to optimize feature selection and construct the predictive model. The model was internally validated by repeated sampling 1000 times based on the Bootstrap method. ResultsA total of 217 patients were included, among which 24 were in the RF group, including 22 males and 2 females, with an average age of (63.33±9.10) years; 193 were in the NRF group, including 161 males and 32 females, with an average age of (62.14±8.44) years. LASSO-logistic regression analysis showed that the percentage of forced expiratory volume in one second/forced vital capacity (FEV1/FVC) to predicted value (FEV1/FVC%pred) [OR=0.944, 95%CI (0.897, 0.993), P=0.026], postoperative anastomotic fistula [OR=4.106, 95%CI (1.457, 11.575), P=0.008], and postoperative lung infection [OR=3.776, 95%CI (1.373, 10.388), P=0.010] were risk factors for postoperative RF in patients with esophageal cancer. Based on the above risk factors, a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.819 [95%CI (0.737, 0.901)]. The Hosmer-Lemeshow test for the calibration curve showed that the model had good goodness of fit (P=0.527). The decision curve showed that the model had good clinical net benefit when the threshold probability was between 5% and 50%. Conclusion FEV1/FVC%pred, postoperative anastomotic fistula, and postoperative lung infection are risk factors for postoperative RF in patients with esophageal cancer. The predictive model constructed based on LASSO-logistic regression analysis is expected to help medical staff screen high-risk patients for early individualized intervention.
Abstract: Objective To investigate the method of improving effect, by investigating and analyzing the possible risk factors affecting shortterm outcome after total correction of tetralogy of Fallot (TOF). Methods Data of 219 patients who received total correction of TOF were divided into two groups according to the length of postoperative stay in hospital and recovery of heart function in the near future. Group A(n=110): patients had good recovery of heart function classified as gradeⅠorⅡ（NYHA classification）, and could smoothly be discharged from the hospital within two weeks without serious complications. The left ventricular ejection fraction (LVEF) had to exceed to 0.50 during 6 months followup visit. Group B(n=109): patients had worse recovery of heart function classified as grade Ⅱ or Ⅲ, and could not be discharged within two weeks with severe complications. LVEF was less than 0.50 during 6 months followup visit. The clinical data of two groups were compared, and risk factors affecting shortterm outcome after total correction of TOF operation were analyzed by logistic regression and model selection. Results There were good recovery of heart function classified as gradeⅠorⅡ(NYHA classification）in discharge, no death, and LVEF all exceeded to 0.50 in group A; there were 8 deaths in group B (7.34 %), and recovery of heart function was worse classified as grade Ⅱ or Ⅲ, with LVEF being less than 0.50（Plt;0.01）. Amount of postoperative daily thoracic drainage, assisted respiration time, time of inotropic agent stabilizing circulation, and the average length of postoperative stay in group A were all less or short than those in group B（Plt;0.01）. But the bypass and clamping time of group B were exceeded group A. The ratio of patching astride annulus in group B was greater than that in group A, and Nakata index was less than that in group A(Plt;0.01). The results of logistic regression and model selection indicate: age at repair (OR=0.69), oxygen saturation(OR=0.98), haematocrit before operation (OR=0.94), and patching astride annulus (OR=46.86), Nakata index (OR=16.90), amount of postoperative daily thoracic drainage (OR=0.84), presence of arrhythmia(OR=0.87), and wound infection(OR=63.57) have significant effect with shortterm outcome after total correction of TOF operation. Conclusions The probable methods to improving effect of shortterm outcome after total correction of TOF are an earlier age at repair, decreasing haematocrit, rising oxygen saturation before surgery, performing a palliative operation facilitating development of arteriae pulmonalis in earlier time, improving the surgical technique, and strengthening the perioperative care.
目的:探讨心肺复苏循环恢复患者早期评估预后的相关因素。方法:对56例心肺复苏循环恢复患者进行病例回顾分析,分别记录患者年龄、性别以及心肺复苏循环恢复1小时内的瞳孔直径、格拉斯高昏迷评分、血WBC计数、血清肌酐Cr、血清丙氨酸氨基转移酶ALT、肌酸磷酸激酶、D-二聚体定性、血钙、血钾、血清淀粉酶、复苏后1小时内是否使用亚低温治疗、pH值、动脉血氧分压PaO2、动脉血二氧化碳分压PaCO2、血葡萄糖、复苏时间等, 采用多因素logistic回归模型分析心肺复苏循环恢复患者的预后因素。结果:回顾56例心肺复苏循环恢复患者病例, logistic回归分析发现血清淀粉酶、血糖和复苏时间对早期评估心肺复苏循环恢复患者的预后有意义。结论:复苏后1小时内血清淀粉酶、血糖和复苏时间对早期评估心肺复苏循环恢复患者的预后有价值。